Dynamic changes in brain structure-function correspondence in typical and atypical upper limb motor recovery after stroke.

Background Converting the transient spasticity-reducing effect of botulinum toxin A (BTX-A) into durable neuroplastic adaptations through mirror therapy (MT) represents a promising yet understudied approach. Although MT facilitates motor recovery, evidence on its long-term synergistic use with BTX-A in chronic stroke remains limited. Aim To investigate the synergistic effects of MT combined with BTX-A on upper limb spasticity and motor recovery in chronic ischemic stroke. Design Randomized, single-blind, sham-controlled clinical trial. Methods and Population Thirty patients with unilateral chronic ischemic stroke and upper limb spasticity were randomized into two groups following BTX-A injection. The experimental group received MT plus standard rehabilitation, while the control group underwent sham therapy using a transparent panel. Interventions began 2 weeks postinjection and were applied three times weekly for approximately 60 sessions over six months. Outcomes were assessed using Brunnstrom recovery stages, modified Ashworth scale (MAS), and Fugl–Meyer assessment for upper extremity (FMA-UE). Results Both groups showed significant within-group improvements in motor and spasticity scores ( p < 0.001). Greater improvements were observed in the MT group for Brunnstrom hand ( p = 0.021), Brunnstrom upper extremity ( p = 0.029), MAS upper extremity ( p = 0.012), and FMA-UE ( p = 0.002). Muscle strength differences were not significant. Conclusion MT combined with BTX-A improves motor recovery and reduces spasticity more than BTX-A alone in chronic stroke, supporting cortical reorganization and neuromuscular relaxation as a cost-effective rehabilitation strategy.

Shoulder-hand syndrome (SHS) is a common upper limb complication following stroke. It is associated with poor functional recovery of the upper limb and reduced mobility. Both kinesiology tape (KT) and manual lymphatic drainage (MLD) are considered effective interventions for treating pain and swelling associated with SHS. However, there is currently no research examining the limitations and safety profile of combining K-tape with MLD for SHS management. This study aims to investigate the efficacy of KT combined with MLD in patients with post-stroke shoulder-hand syndrome. This study will be a prospective, single-center, randomized, factorial, controlled clinical trial. This exploratory randomized controlled trial aimed to investigate the efficacy of MLD combined with KT for post-stroke SHS. This study used a blinded design. Ninety-six patients with post-stroke SHS are randomly divided into four groups: (n = 24 per group): Experimental Group 1: Conventional Rehabilitation (CR) + KT, Experimental Group 2: Conventional Rehabilitation (CR) + MLD, Experimental Group 3 (EG3): KT + MLD, Control Group: CR alone. All participants will receive CR as the baseline intervention. All subjects are first‑ever stroke patients diagnosed with unilateral limb paralysis by CT and/or MRI and meet the diagnostic criteria for SHS. The informed consent process is carried out by a trained researcher not involved in the patients' clinical care in a private room. Therapists participating in this study must hold a rehabilitation therapist qualification. Unified training will be provided to the treating therapists on MLD, KT, and conventional rehabilitation techniques. This study is conducted at the Army Specialized Medical Center. The Army Specialized Medical Center is a tertiary Grade A hospital located in Southwest China. In China's hierarchical medical system, tertiary Grade A hospitals represent the highest level in the hospital classification system. Outcome measures will be assessed at four time points: baseline (T0), 4weeks after initiating the intervention (T1), 3months post-treatment (T2), 6-month follow-up (T3). The primary endpoints will be as follows: pain intensity measured by the Visual Analogue Scale (VAS) at T1, volume difference between the affected and unaffected upper limbs at T1. Secondary endpoints will include the following: upper limb motor function assessed by the Fugl-Meyer assessment for upper extremity (FMA-UE), activities of daily living evaluated using the modified Barthel index (MBI), joint range of motion (ROM) measurements, quality of life measured by the Stroke-specific quality of life scale (SS-QOL). Safety is assessed by monitoring vital signs (blood pressure and heart rate) before and after treatment, examining skin integrity at the tape application site for any adverse reactions (e.g., redness, rash), and recording any patient-reported increases in pain or other unexpected discomfort potentially related to the intervention. The efficacy of personalized rehabilitation therapy prescription interventions will be assessed through changes in primary and secondary outcome measures at the 4-week intervention point and during the 12-week follow-up period. To analyze whether MLD combined with KT for post-stroke shoulder-hand syndrome is superior to conventional rehabilitation in terms of pain, swelling, and motor function. Clinical Trial Registry-China ChiCTR2300074140.https://www.chictr.org.cn/. First submitted on 31 July 2023.

BackgroundBrain-computer interface-driven functional electrical stimulation (BCI-FES) is a promising approach for post-stroke upper limb rehabilitation. However, considerable variability exists in stimulation parameters and task designs across studies, and evidence remains insufficient to support definitive protocol recommendations.MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) up to September 2025. Eligible studies applied BCI-FES and reported the Fugl-Meyer Assessment for the upper extremity (FMA-UE). Risk of bias was assessed with the PEDro scale, and evidence certainty graded with GRADE. Random-effects meta-analyses were performed.ResultsTwelve RCTs (n = 619) showed BCI-FES improved FMA-UE scores versus controls (MD = 5.82, 95% CI 3.04-8.59, p < 0.00001; I2 = 39%), with larger benefits in subacute stroke (MD = 8.45). Dynamic-threshold paradigms and motor imagery were associated with higher effect sizes. Higher stimulation frequency (>50 Hz), narrow-pulse width (150 µs) more frequent sessions (≥5/week), shorter session duration (≤30 min), greater total sessions (>20), and longer intervention (>4 weeks) tended to be associated with larger effect sizes, though evidence is limited and based on few studies. Secondary outcomes (ARAT, WMFT, MBI) improved, and no serious adverse events were reported. Evidence certainty was moderate.ConclusionBCI-FES was associated with improvements in upper limb motor recovery after stroke, especially in subacute patients. Some stimulation and training features may relate to greater effects, but current evidence remains insufficient for definitive clinical guidance. Larger multicenter RCTs are needed to clarify dose-response relationships and support biomarker-guided, personalized interventions.

Background Digital health–driven rehabilitation systems incorporating Internet of Things (IoT) technologies have attracted increasing attention as a means to support upper limb motor recovery after stroke. However, detailed clinical descriptions of their implementation in routine inpatient rehabilitation remain limited. Case presentation We report the case of a right-handed man in his forties with right-sided upper limb motor impairment following putaminal hemorrhage. The patient underwent rehabilitation using a digital health–driven IoT-based upper limb rehabilitation system starting approximately one month after stroke onset during the convalescent rehabilitation phase. Intervention The intervention was conducted over a two-week period, consisting of 10 sessions (approximately 40 min per session) as part of routine inpatient rehabilitation. The system integrated a portable smart projector, a three-dimensional motion capture sensor, and a communication robot to deliver interactive, task-oriented training. Five activities of daily living–oriented tasks (wiping, unlocking, squeezing, cup transfer, and typing) were implemented, with task difficulty adjusted by the treating occupational therapist according to the patient's performance. Outcomes Upper limb motor function assessed by the Fugl–Meyer Assessment for the Upper Extremity improved from 63 to 66. Real-world arm use assessed by the Motor Activity Log showed an Amount of Use score of 5 both before and after the intervention, suggesting a ceiling effect, while the Quality of Movement score improved slightly from 4.8 to 5. The patient demonstrated high engagement and adherence throughout the intervention, and no adverse events were observed. Conclusion This case report demonstrates the clinical feasibility of integrating a digital health–driven IoT rehabilitation system into routine inpatient stroke rehabilitation. Although generalization is limited by the single-case design, the present case highlights the potential of IoT-based digital health technologies to support task-oriented training and patient engagement in upper limb rehabilitation.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of contralaterally controlled functional electrical stimulation (CCFES) compared with neuromuscular electrical stimulation (NMES) for upper limb motor impairment in people after stroke.

Using cross-sectional data from 26 general hospitals in China that treated stroke patients in the Department of Rehabilitation Medicine, the aim of this research is to explore the potential association between upper limb motor function and balance function after stroke. We conducted a prospective cross-sectional study involving 1573 stroke patients hospitalized in the rehabilitation medicine departments of 26 hospitals across China. Upper limb motor function and balance were evaluated using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and the Berg Balance Scale (BBS), respectively. Linear regression analysis and smoothing curve fitting were performed to examine the relationship between upper limb motor and balance functions. This study included 1573 non-pregnant adults aged 18years or older, with a mean age of 61.2 ± 12.5years, of whom 69.0% were male. After adjusting for potential confounders, a significant positive association was observed between upper limb motor function and balance function after stroke (β = 0.48, 95% CI: 0.44-0.51, p < 0.001). Subgroup analyses indicated that this association was more pronounced in the acute phase (≤ 7days) compared with the subacute and recovery phases. No significant interactions were detected across other subgroups (p > 0.05 for all interactions). Smooth curve fitting revealed distinct saturation effects for FMA-UE and BBS, with inflection points at 25 and 45, respectively. Sensitivity analyses further confirmed these results, supporting the robustness of the findings. This study identified a significant positive association between upper limb motor function and balance function following stroke, highlighting the potential role of upper limb motor recovery in predicting balance outcomes. Further large-scale and multidimensional studies are needed to clarify the underlying mechanisms linking upper limb motor control and post-stroke balance function.

Median nerve, a major peripheral nerve, connects the hand to the central nervous system, facilitating upper limb motor function and sensation by transmitting sensory data from the palm and fingers. Damage to this nerve can result in motor and sensory deficits, with carpal tunnel syndrome (CTS) causing compression, leading to tingling and numbness in the thumb, index, middle, and lateral ringfingers. This study aimed to develop an accurate deep-learning-based segmentation method for measuring the cross-sectional area (CSA) of the median nerve to facilitate the diagnosis of nerve entrapment syndromes and aid in surgical planning, with a focus onCTS. This study introduces MNSeg-Net, a novel lightweight multiscale feature fusion network with 2.46M parameters for median nerve segmentation in ultrasound (US) frames, specifically designed to enable a fully automated, end-to-end clinical setup supporting real-time segmentation and CSA computation. The dataset comprised 100 subjects and 30000 ultrasound frames, which were split into training (80%), validation (10%), and testing (10%) subsets with subject-wise separation to avoid data leakage. MNSeg-Net was benchmarked against state-of-the-art segmentation models, including UNet and its variants (UNet++ and U2Net). The performance was assessed using metrics such as the Dice similarity coefficient (DSC) and CSA difference. The statistical significance of performance differences was evaluated using paired t-tests, effect size (Cohen's d), and one-way ANOVA with Tukey's HSD correction for multiple comparisons at a -value threshold of 0.05, while statistical equivalence between models within predefined margins was formally assessed using the two one-sided test (TOST) procedure. Following quantitative validation, the model was deployed in a real-time clinical setup utilizing an Av.io HD Epiphan frame grabber to stream ultrasound images from the ultrasound machine to a GPU-equipped system. A secondary display running parallel to the original ultrasound screen visualized the segmented median nerve and computed the CSA values in realtime. MNSeg-Net achieved high segmentation performance, with average DSC scores of 94.7% at the wrist and 83.4% from the wrist to the elbow, and the lowest Hausdorff distance, matching the performance of the best-performing 44-million-parameter heavy U2Net model. Compared to U2Net, MNSeg-Net showed no statistically significant difference in DSC performance ( ; Cohen's ; mean difference = -0.001), with formal equivalence testing confirming equivalence across all tested margins ( ). For CSA estimation, MNSeg-Net also showed no statistically significant difference from clinician-annotated values ( ; Cohen's ; mean difference = -0.081), and equivalence was established at the margin, confirming a strong alignment with expert clinical assessments. MNSeg-Net demonstrated real-time performance by processing up to 43 frames per second on a single GPU, successfully segmenting the median nerve and computing CSA from ultrasoundframes. The developed MNSeg-Net-based clinical system represents an important step toward real-time median nerve assessment, enabling a fully automated solution for CTS diagnosis. By combining a lightweight architecture, real-time processing capability, and successful clinical deployment, it represents a substantial advancement in the CTS detection andmanagement.

Rehabilitation effects of Tuina combined with occupational therapy on upper-limb motor function and cognitive function in patients with poststroke cognitive impairment

Resting-state and task-state fNIRS fusion assessment method for upper limb motor function in stroke patients.

ABSTRACT Cognitive impairments in Parkinson’s disease (PD) often emerge alongside motor symptoms, yet most clinical assessments examine these domains separately. This mixed-design study explores the utility of a virtual reality-based Color Trails Test (VR-CTT) as an integrated, immersive tool to assess motor-cognitive interaction in PD. Twenty-three individuals with PD (ON medication) and twenty-three age- and education-matched healthy controls completed both the standard pen-and-paper CTT and the VR-CTT, which preserves the same cognitive demands while introducing an upper-limb motor component through full-arm reaching to virtual targets. As expected, individuals with PD were slower and less accurate across both formats. However, we observed only moderate-to-low correlations between completion times in the two CTTs, thus suggesting that the VR-CTT may capture distinct and ecologically valid aspects of motor-cognitive performance. Indeed, kinematic analysis revealed longer head-hand coordination delays and reduced maximal execution velocities in PD, pointing to subtle, yet specific motor difficulties during cognitive tasks. Beyond confirming feasibility, these results highlight the VR-CTT’s potential as a novel tool for identifying motor-cognitive dysfunction and informing targeted rehabilitation strategies. Its immersive nature and multi-competency format position it as a promising intervention platform for cognitive-motor training in PD and related disorders.

Stroke is a leading cause of long-term upper limb disability, severely impacting patients' independence and quality of life. Robot-assisted therapy (RAT) has emerged as a promising, high-intensity rehabilitation alternative. However, conclusions from existing systematic reviews on its efficacy are inconsistent and often lack a holistic framework, limiting their use for guiding personalized clinical decisions. This study aims to systematically synthesize recent evidence on RAT for upper limb rehabilitation after stroke. Guided by the International Classification of Functioning, Disability and Health framework, it moves beyond singular outcomes to provide a multidimensional evaluation across body function, activity, and participation levels. The review aims to provide stratified guidance for clinical decision-making based on patient- and intervention-specific characteristics, thereby supporting evidence-based practice and informing future research. This study included systematic reviews and meta-analyses published from January 1, 2019, to December 26, 2025, comparing RAT with conventional therapy for upper limb rehabilitation after stroke. Overall, 6 databases, including PubMed, Web of Science, and Embase, were searched. Two reviewers (XZ and LZ) independently performed study selection, data extraction, and quality assessment using the AMSTAR 2 tool. The synthesis integrated outcome measures and subgroup analyses derived from the included studies. This umbrella review included 21 meta-analyses encompassing 535 randomized controlled trials and 27,598 patients across acute, subacute, and chronic stroke stages. According to AMSTAR 2, 17 reviews were high quality, 3 moderate, and 1 critically low. The synthesis demonstrated that RAT was superior in improving upper limb motor function, but no statistically significant advantages were observed in activities of daily living compared to conventional therapy. Subgroup analyses revealed that treatment effects were influenced by stroke stage, upper limb motor impairment level, and robot type. RAT is an effective intervention for improving upper limb motor function after stroke. However, its benefits are primarily observed at the level of body function, with limited evidence for long-term maintenance. The current evidence is constrained by significant outcome heterogeneity and methodological limitations inherent to umbrella reviews. Future research should validate these findings in broader clinical practice, focus on translating functional gains into sustained improvements in daily activities and participation, and include cost-effectiveness evaluations. PROSPERO CRD42024497183; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024497183.

It is common for researchers in spinal cord injury (SCI) to treat limbs from the same individual as independent to increase sample size in limb-based analyses. However, this approach may violate independence assumptions required for traditional statistical tests. This study investigated the dependence of bilateral upper-limb motor and neurophysiological outcomes through a retrospective analysis of participants from the European Multicenter Study about Spinal Cord Injury. Data from 118 participants with acute cervical SCI (236 limbs) were analyzed, including ulnar compound muscle action potentials (CMAPs) recorded in the abductor digiti minimi and manual muscle scores for the flexor digitorum profundus, bilaterally assessed at 12 and 48 weeks postinjury. Our analysis stratified participants by injury severity into two groups: motor complete (n = 55) and motor incomplete (n = 63). Interlimb dependence was assessed using Spearman's rank correlations. To illustrate the implications of such dependence for inference, bootstrap analyses of motor recovery (12 vs. 48-week CMAPs) compared three analytical approaches using a linear mixed-effects model framework: randomly selecting outcomes from one limb per participant, including both limbs but ignoring intraparticipant correlation, and including both limbs but accounting for intraparticipant correlation. Bootstrap resampling was performed across sample sizes ranging from n = 10 to 50. Moderate-to-strong correlations (Spearman's rho = 0.44-0.91) were observed between bilateral CMAPs and bilateral strength scores in both groups at 12 and 48 weeks postinjury. All models yielded similar CMAP recovery estimates (∼1.6 to 1.8 mV), but the precision of these estimates and the empirical power, reflecting the probability of detecting a significant recovery effect given the observed effect size and variability, varied across methods. Treating limbs as independent overestimated precision, resulting in the highest power estimates, whereas including only one limb reduced statistical power, particularly at lower sample sizes. Accounting for intraparticipant dependence yielded intermediate estimates of precision and power. These findings demonstrate that bilateral upper-limb outcomes in SCI are statistically dependent and highlight the need for statistical procedures that account for intraparticipant correlation in SCI research to ensure valid study conclusions.

Background/Objectives: Stroke is among the leading causes of disability in adults, as hemiparesis affects motor function and daily activities. Constraint-induced movement therapy (CIMT) has proven effective in functional recovery through intensive use of the affected limb. This study aimed to assess the impact of CIMT on upper limb (UL) rehabilitation in stroke patients, with a focus on motor recovery, integration into activities of daily living (ADLs), and overcoming clinical implementation barriers. Methods: A systematic review was conducted by searching PubMed, Scopus, and Web of Science from their inception to March 2026. Systematic reviews and meta-analyses evaluating the effectiveness of CIMT in adult patients after stroke were included. The outcome variables included motor function, movement quality, independence in ADLs, and quality of life (QoL). Results: Twenty-five systematic reviews and sixteen meta-analyses were included. The participants were adults who had suffered a stroke at acute, subacute, or chronic stages and were aged between 18 and 95 years. With respect to upper limb motor function, ten studies reported statistically significant results in favor of CIMT. With respect to ADLs, four studies reported significant differences in favor of CIMT, with strong effects in intensive interventions. With respect to QoL, three studies reported significant improvements after the intervention. Conclusions: The results of this umbrella review support the effectiveness of CIMT in UL rehabilitation after stroke, especially in the subacute and chronic phases. CIMT, alone or in combination with adjuvant therapies, contributes to improving motor function, independence in ADLs, and QoL in patients.

Surface electromyography (sEMG) provides a non-invasive measure of the neural drive transmitted from the central nervous system to muscles by capturing the spatiotemporal summation of motor unit action potentials at the skin surface, and is therefore widely used to study neuromuscular coordination during motor tasks. By reflecting neural drive transmitted from the central nervous system to peripheral muscles, sEMG provides valuable insights for investigating neuromuscular coordination during upper-limb motor tasks. Within the framework of modular motor control, muscle synergy analysis has been increasingly applied to characterize coordinated muscle activation patterns extracted from multi-channel sEMG recordings. In this study, sEMG signals were collected from twelve stroke patients and nine healthy subjects during robot-assisted upper-limb training, involving two movement trajectories (straight and rectangular) and multiple robot-assisted levels. Muscle synergies were extracted using non-negative matrix factorization (NMF). A synergy merging-splitting model, combined with a Functional Driving Ratio (FDR), was employed to characterize both the muscle synergy reorganization and the relative activation contributions of driving versus stabilizing muscle components in terms of motor control strategy. The results showed that healthy subjects maintained consistent muscle coordination patterns across different assistive levels, while making task-dependent adjustments to muscle activation to adapt to variations in movement trajectories. For stroke patients, higher functional status was correlated with more differentiated coordination patterns and relatively higher FDR values, suggesting greater reliance on task-relevant agonist muscles during movement execution. In contrast, lower-function patients exhibited less differentiated coordination patterns accompanied by reduced FDR values, indicating the increased involvement of stabilizing or antagonist muscles. This shift may reflect compensatory control strategies and the reduced efficiency of neuromuscular coordination during assisted upper-limb movements. These findings suggest that sEMG-based muscle synergy features and the FDR may provide quantitative, sensor-derived support for characterizing neuromuscular coordination during robot-assisted rehabilitation.

Action observation treatment and virtual reality are established approaches for upper limb rehabilitation after stroke. This study investigated whether combining action observation with virtual reality improves hand dexterity and upper limb motor recovery compared with virtual reality alone. In this multicenter, assessor-blinded randomized controlled trial conducted in inpatient rehabilitation centers in Italy between January 2022 and September 2024, poststroke adults with hemiplegia (n=48) were assigned to the experimental or to the control group. Both underwent 20 one-hour sessions over 5 weeks. Participants of the experimental group observed goal-directed daily actions before replicating them in virtual reality, whereas participants of the control group viewed nature scenes before performing the same virtual reality tasks without action observation. Motor function was evaluated at baseline, postintervention, and 6-month follow-up using the Box and Block Test, with the primary estimand defined as the between-group difference in change in paretic hand scores. Secondary outcomes included measures of muscle strength, spasticity, global disability, and functional independence. Both groups showed improvement in Box and Block scores for both hands. However, the experimental group demonstrated a greater gain in paretic hand function, with a between-group difference in change of 7.8 blocks at posttreatment (95% CI, 7.1-7.9) and 10.8 blocks at 6-month follow-up (95% CI, 10.6-10.9). Improvements in the nonparetic hand were comparable between groups. Similar improvements across both groups were observed in secondary outcome measures. A significant treatment×age×time-from-stroke interaction was observed for paretic hand dexterity, indicating that treatment effects varied according to these covariates. Action observation combined with virtual reality appears to be more effective than virtual reality alone for promoting upper limb motor recovery after stroke, particularly in enhancing fine motor function of the paretic hand. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05163210.

Transcranial focused ultrasound (tFUS), a non-invasive brain neuromodulation, can target deeper and more precise brain regions compared to transcranial magnetic stimulation. However, its safety, neuromodulation and therapeutic effects in subacute stroke patients remain unclear. Therefore, the aim of this project is to demonstrate the safety and preliminary efficacy of tFUS for upper limb motor recovery in subacute stroke patients. In this phase I single-arm study, we recruited 10 patients with subacute (≤ 3 months) unilateral stroke. tFUS was applied to the contralesional M1 by neuronavigation once daily for five sessions, using ISPTA 2.8W/cm² in free field (estimated in situ < 0.3W/cm²), MI 0.75, PRF 100Hz, and duty cycle 30%, with 10-minute exposure per session. The primary outcome was safety over 12 weeks. Secondary outcomes included cortical excitability (evaluated by transcranial magnetic stimulation and functional near-infrared spectroscopy) and functional measures assessed pre-treatment and at 1day, 1 week, 4 weeks, and 12 weeks.) RESULTS: Ten patients completed the trial, and the safety analysis revealed no severe adverse events (AEs), new imaging abnormalities, or neuropsychological decline; only minor transient AEs occurred in 5 of 10 patients. tFUS showed preliminary therapeutic efficacy, with improvements in hemiplegic upper limb motor recovery and functional performance. Greater FMA improvement was observed in the tFUS group compared with age-, sex-, and baseline FMA-matched patients who received rTMS. Exploratory analyses of cortical excitability measures showed bilateral trends toward facilitation; however, these changes did not reach statistical significance. tFUS was safe and well tolerated in subacute stroke patients, with only minor transient AEs and no evidence of structural or neuropsychological harm. tFUS demonstrated potential to enhance upper limb motor recovery and functional outcomes. Although exploratory analyses suggested trends toward cortical excitability changes, these findings were not statistically significant and require confirmation in larger controlled trials.

Upper limb motor dysfunction resulting from stroke requires effective rehabilitation solutions; however, current exoskeletons are limited by single-input control, inadequate adaptation to various rehabilitation stages, and restriction to one limb. This study presents the development of a three-degree-of-freedom upper limb rehabilitation exoskeleton with three core innovations: (1) a neuro-fuzzy adaptive admittance control architecture that integrates human-robot interaction force and joint angular velocity as dual inputs for real-time damping adjustment, enabling accurate capture of dynamic movement intentions; (2) a Brunnstrom stage-specific fuzzy rule base that directly links clinical rehabilitation needs to adaptive control parameters; (3) a bilateral adaptable mechanical structure, allowing dual-upper limb training to enhance practical application. By combining radial basis function (RBF) neural network-based adaptive proportional-integral-derivative (PID) control with fuzzy variable-parameter admittance control, the system achieves a maximum trajectory tracking error of less than 1.2° and a root mean square (RMS) error of ≤0.13°. Trajectory tracing experiments confirm an RMS error of 2.99 mm for a circular trajectory at Bd = 2. The proposed strategy, validated through position tracking, admittance interaction, and trajectory tracing experiments, effectively balances tracking accuracy and human-machine compliance, providing valuable technical support for robot-assisted upper limb rehabilitation.

Stroke causes muscle atrophy and functional decline, affecting quality of life. Exercise training reduces post-stroke muscle loss. This study explores if rehabilitation robots enhance upper-limb function and muscle mass in stroke patients. We selected 80 patients who visited the North China University of Science and Technology Affiliated Hospital from June 2024 to April 2025 for a randomized controlled trial. After excluding missing values, the patients were divided into two groups: the control group (n = 38) and the intervention group (n = 39). The control group received 4weeks of conventional rehabilitation therapy, while the intervention group underwent upper-limb robot-assisted training in addition to the conventional therapy. The primary outcomes comprised the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) score, handgrip strength (HG), and the appendicular skeletal muscle mass index (ASMI). After 4weeks of treatment, significant differences were observed in the FMA-UE scores, HG, and ASMI between the two groups (P < 0.05). The intervention group showed superior outcomes compared to the control group, with statistically significant differences (P < 0.05). This study provides evidence that robot-assisted training improves upper-limb motor function and enhances sarcopenia-related indicators-specifically muscle mass and muscle strength-in acute stroke patients.

Robot-assisted therapy (RAT) with exoskeletons is believed to enhance motor recovery in stroke survivors. RAT offers intensive, feedback-based, task-oriented training to improve function. This study evaluated exoskeleton-based RAT integrated into usual rehabilitation care for individuals in early subacute stroke. This multicenter randomized controlled trial was conducted across 8 stroke neurorehabilitation units over a 3-year period (December 2020-March 2024). Inpatients with moderate-to-severe upper limb impairment postsubacute stroke (<3 months poststroke) were randomized (1:1) to 25 sessions (5/week for 5 weeks) of exoskeleton-assisted RAT (robotic group) or conventional rehabilitation (control group). Outcome assessors were blinded. The primary outcome was the change in the Fugl-Meyer Assessment for Upper Limb (motor section, 0-66) from baseline to treatment end. Secondary outcomes addressed body function, activity (capacity/performance), and participation. Clinical assessments were at baseline (T0), posttreatment (T1), and 6-month telephone follow-up (T2). Odds ratio for achieving a minimal clinically important difference (≥10 points) on the Fugl-Meyer Assessment for Upper Limb was calculated. A total of 109 individuals with subacute stroke were screened. Of these, 94 (35% women; mean age 62.5±13.5 years; mean onset 34±28 days) were eligible and randomized, and 82 completed the intervention (12% dropout). No significant differences were observed at baseline, despite the median Fugl-Meyer score being 16 in the robotic group and 10 in the control group. The robotic group showed significantly greater improvement in Fugl-Meyer Assessment for Upper Limb motor score than the control group, with a median between-group difference of 22 points (P<0.001). Minimal clinically important difference was reached by 68.4% in the robotic group versus 31.8% in the control group (odds ratio, 4.64 [95% CI, 1.83-11.8]; P<0.001). All secondary outcomes improved significantly in both groups with no significant differences between groups, except for spasticity, which showed no significant change. Exoskeleton-assisted RAT offers significant clinical benefits in early poststroke upper limb recovery, yielding higher minimal clinically important difference rates on impairment outcomes but not on specific functional measures compared with conventional therapy. Further research should evaluate long-term effects and optimize protocols based on patient characteristics. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04697368.